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Int J Cancer. 2017 May 1;140(9):1976-1984. doi: 10.1002/ijc.30618. Epub 2017 Feb 27.

Alcohol and lung cancer risk among never smokers: A pooled analysis from the international lung cancer consortium and the SYNERGY study.

Author information

1
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.
2
International Agency for Research on Cancer, Lyon, France.
3
Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.
4
Department of Epidemiology, School of Public Health, UCLA, Los Angeles, CA.
5
Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT.
6
Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.
7
Division Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
8
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
9
Division of Epidemiology, Public Health and Primary Care, Faculty of Medicine, Imperial College London, London, United Kingdom.
10
Department of Public Health, Section for Epidemiology, Aarhus University, Denmark.
11
Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom.
12
Hellenic Health Foundation, Athens, Greece.
13
World Health Organization Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
14
Unit of Cancer Epidemiology, Piedmont Children Cancer Registry, Città della Salute e della Scienza di Torino Hospital and CPO Piemonte, Turin, Italy.
15
Department of Environmental Epidemiology, INSERM, Villejuif, U170, France.
16
Mount Sinai School of Medicine, The Tisch Cancer Institute, New York, NY.
17
Harvard School of Public Health, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
18
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
19
Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI.
20
Karmanos Cancer Institute, Wayne State University, Detroit, MI.
21
Department of Community Medicine and Epidemiology, Carmel Medical Center and Bruce Rappaport Faculty of Medicine, Israel Institute of Technology and Clalit Health Services National Cancer Control Center, Haifa, Israel.
22
Public Health Ontario, Toronto, Canada.
23
Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
24
College of Public Health, The Ohio State University, Columbus, OH.
25
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
26
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
27
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
28
Weill Cornell Medical College, Cornell University, New York, NY.
29
Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
30
CIBER de Epidemiología y Salud Pública, Madrid, Spain.
31
University of Montreal Hospital Research Center (CRCHUM) and School of Public Health, Montreal, Canada.
32
Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, Washington.
33
IUOPA, University Institute of Oncology, University of Oviedo, and CIBERESP, Spain.
34
University of Hawaii Cancer Center, Honolulu, Hawaii.
35
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
36
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
37
German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
38
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
39
Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Lebanon, USA.
40
The Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland.
41
Department of Cancer Epidemiology and Prevention, Cancer Center Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland.
42
Institute of Carcinogenesis, Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia.
43
National Institute of Environmental Health, Budapest, Hungary.
44
Specialized Institute of Hygiene and Epidemiology, Banská Bystrica, Slovakia.
45
National Institute of Public Health, Bucharest, Romania.
46
Masaryk Memorial Cancer Institute, Brno, Czech Republic.
47
Palacky University, Olomouc, Czech Republic.
48
Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
49
Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
50
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
51
The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

Abstract

It is not clear whether alcohol consumption is associated with lung cancer risk. The relationship is likely confounded by smoking, complicating the interpretation of previous studies. We examined the association of alcohol consumption and lung cancer risk in a large pooled international sample, minimizing potential confounding of tobacco consumption by restricting analyses to never smokers. Our study included 22 case-control and cohort studies with a total of 2548 never-smoking lung cancer patients and 9362 never-smoking controls from North America, Europe and Asia within the International Lung Cancer Consortium (ILCCO) and SYNERGY Consortium. Alcohol consumption was categorized into amounts consumed (grams per day) and also modelled as a continuous variable using restricted cubic splines for potential non-linearity. Analyses by histologic sub-type were included. Associations by type of alcohol consumed (wine, beer and liquor) were also investigated. Alcohol consumption was inversely associated with lung cancer risk with evidence most strongly supporting lower risk for light and moderate drinkers relative to non-drinkers (>0-4.9 g per day: OR = 0.80, 95% CI = 0.70-0.90; 5-9.9 g per day: OR = 0.82, 95% CI = 0.69-0.99; 10-19.9 g per day: OR = 0.79, 95% CI = 0.65-0.96). Inverse associations were found for consumption of wine and liquor, but not beer. The results indicate that alcohol consumption is inversely associated with lung cancer risk, particularly among subjects with low to moderate consumption levels, and among wine and liquor drinkers, but not beer drinkers. Although our results should have no relevant bias from the confounding effect of smoking we cannot preclude that confounding by other factors contributed to the observed associations. Confounding in relation to the non-drinker reference category may be of particular importance.

KEYWORDS:

alcohol; beer; liquor; lung cancer; wine

PMID:
28120396
PMCID:
PMC5356930
DOI:
10.1002/ijc.30618
[Indexed for MEDLINE]
Free PMC Article

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